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Six-month outcomes following an emergency hospital admission for older adults with co-morbid mental health problems indicate complexity of care needs
- Authors:
- BRADSHAW Lucy E., et al
- Journal article citation:
- Age and Ageing, 42(5), 2013, pp.582-588.
- Publisher:
- Oxford University Press
Background: Two-thirds of older patients admitted as an emergency to a general hospital have co-existing mental health problems including delirium, dementia and depression. This study describes the outcomes of older adults with co-morbid mental health problems after an acute hospital admission. Methods: A follow-up study of 250 patients aged over 70 admitted to 1 of 12 wards (geriatric, medical or orthopaedic) of an English acute general hospital with a co-morbid mental health problem and followed up at 180 days. Results: Twenty-seven per cent did not return to their original place of residence after the hospital admission. After 180 days 31% had died, 42% had been readmitted and 24% of community residents had moved to a care home. Only 31% survived without being readmitted or moving to a care home. However, 16% spent >170 of the 180 days at home. Significant predictors for poor outcomes were co-morbidity, nutrition, cognitive function, reduction in activities of daily living ability prior to admission, behavioural and psychiatric problems and depression. Only 42% of survivors recovered to their pre-acute illness level of function. Clinically significant behavioural and psychiatric symptoms were present at follow-up in 71% of survivors with baseline cognitive impairment, and new symptoms developed frequently in this group. Conclusions: The variable, but often adverse, outcomes in this group implies a wide range of health and social care needs. Community and acute services to meet these needs should be anticipated and provided for. (Publisher abstract)
Carers for older people with co-morbid cognitive impairment in general hospital: characteristics and psychological well-being
- Authors:
- BRADSHAW Lucy E., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 28(7), 2013, pp.681-690.
- Publisher:
- Wiley
To describe the characteristics and well-being of carers of older people with mental health problems admitted to a general hospital, patients aged 70 years or older with unplanned admission to an acute general teaching hospital in the UK were screened for mental health problems. Those screened positive, together with a carer, were invited to undergo further assessment with a battery of health status measurements. Carers were interviewed to ascertain strain (caregiver strain index (CSI)), psychological distress (12-item General Health Questionnaire) and quality of life (EQ-5D). Two hundred and fifty patients were recruited to the study, of whom 180 were cognitively impaired and had carers willing to take part. After 6 months, 57 patients (32%) had died, and follow up was completed on 100 carers. Carers' own health, in terms of mobility, usual activities, and anxiety, was poor in a third of cases. At the time of admission, high carer strain was common, particularly among co-resident carers. High levels of behavioural and psychiatric symptoms at baseline were associated with more carer strain and distress. At follow-up, carer strain and distress had reduced only slightly, with no difference in outcomes for carers of patients who moved from the community to a care home. The authors conclude that hospital staff should be alert to sources of carer strain and offer carers practical advice and emotional support. Interventions are required to prevent and manage behavioural and psychiatric symptoms at the time of acute physical illness or to alleviate their effects on carers. (Edited publisher abstract)